Bathrooms that are so dirty you can't use them without cleaning them first yourself. A midwife who informs you she is too busy to help you bath your baby. A ward so overcrowded that your husband feels in the way. You long to leave it although you're still shattered after a 20-hour birth.

Britain's maternity services in 2005 are neither as good nor as safe as they should be, according to a report from the government's health inspectorate which will be presented to MPs tomorrow.

The report comes less than two months after The Observer's Better Birth Campaign revealed the problems faced by women during birth.

The report reveals many of the same issues first uncovered by The Observer campaign. Poor leadership on the wards, doctors who do not explain what is happening to patients, dirty toilets and an acute shortage of midwives are just a few of the problems being thrown into the spotlight by Sir Ian Kennedy, chairman of the Healthcare Commission.

Kennedy believes these factors are making childbirth more hazardous than necessary. Investigations carried out by the commission at three maternity units where they have had high mortality rates over the past two years have revealed the nature of the scandal. One of the worst was at Northwick Park in north London, where 10 women died during or after birth. An inquiry published earlier this year found that staff were overstretched, working in cramped conditions and often with inadequate equipment.

It is not lack of money, but poor NHS management which is the cause of the problems, according to the report.

'Our work has shown that there is too much poor practice that needs to be rooted out.' said Kennedy. 'Giving birth is probably safer now, in overall terms, than it ever was and there are lots of examples of good practice. However, this is an area where the consequences of things going wrong are very great.

'There is growing evidence that in some places maternity services are not as good or as safe as they should be.'

His report points out that the collection of data by the NHS is so patchy that at the moment the commission does not even know which maternity centres are the worst. They only hear about it when the number of deaths or injuries become too high. The government will respond by publishing its own action plan for 'world-class maternity care' on Wednesday. The health minister, Liam Byrne, is setting up an advisory group to set standardsfor units to meet.

Byrne, who has spent the past two months working on the plans, told The Observer last night: 'I am personally concerned that not enough units are reaching the standards of the best. When you look at the outstanding centres, you can see really good leadership on the wards; I think it's critically important.'

He is also keen to find out more about what kind of choices women want when it comes to giving birth, and has commissioned research which will ask hundreds of women about their experiences.

Kennedy wants speedy action to improve matters. First, he would like to see every hospital start to analyse the quality of their maternity services by looking at the known risk factors and measuring themselves against them.

They also need to supply the right information about their services to the commission. Hospitals that fail to do this will face spot checks from inspectors.

The concerns about maternity care, contained in the commission's annual report to Parliament, go much further than safety. The comments paint a picture of how women are being let down by maternity units. It highlights patients' complaints that midwives often do not have the time to explain what is happening to them. There is a lack of advice on feeding, bathing and how to settle the baby to sleep.

Very often, the units are overcrowded and there is a poor standard of cleanli ness. During the birth, delays are caused by faulty equipment. When babies die, too often the bereaved couples do not know what went wrong.

The Better Birth Campaign called on ministers to give priority to improving the physical state of the wards and to do more to ensure that women would have one-to-one care during births.

One of the mothers we featured, Natalie Champion, experienced the best and the worst of the NHS last year. She had to wait a long time before eventually having a forceps birth. Her baby, Taye, was fine. 'The last midwife I had was lovely and that made a huge difference to me. Being your first, you don't have a clue what's going on,' she recalled.

But it was the postnatal care that let her down. Champion found out that there were 28 women in the unit at St George's Hospital in Tooting, south London, that day. 'They did their very best, but it was so noisy and crowded. Frankly, I couldn't wait to get out after the birth.'

One concern is that poorer women have a worse experience than the better-off. A recent study showed that women living in the most deprived areas of England had a 45 per cent higher death rate compared to women living in more affluent areas. Women from minority ethnic groups were, on average, three times more likely to die.

This could be to do with a lack of access to good antenatal services, where problems can be picked up early, or it could lie more in communication problems between staff and patients.

Every year, there are around 650,000 births in the UK and more than 90 per cent take place in NHS hospitals. Some 46 per cent of deliveries are defined as 'normal', 22 per cent - a growing number - are by caesarean section and 11 per cent by forceps. But despite the costs of litigation associated with birth accidents, there is a lack of risk management within the maternity units, and many incidents go unreported.

Another concern is that the shortage of midwives - some 10,000 short according to the Royal College of Midwives - is compounded by an over-reliance on agency staff who are not being properly supervised.

But according to Kennedy, the root cause of poor performance is often weak managerial or clinical leadership

Gill Morgan, head of the NHS Confederation which represents managers, said they were taking the report seriously, but she did not feel all the blame should go on administrators. 'Solving the problem needs a multi-disciplinary response with managers and clinicians working together and midwives and obstetricians working together. There is a historical problem of midwife shortages.'

But Kennedy, a lawyer who made his name by chairing the inquiry into the deaths of children undergoing heart surgery in Bristol, is to call on the boards of NHS trusts to put in place immediately the means to assess their services against national standards.

The stakes are high, as Kennedy explained. 'Very few mothers and babies die or suffer serious damage. But the numbers could be smaller if we threw the spotlight on maternity more often and not just in the aftermath of a serious problem.

'The last thing I want is to be complaining this time next year about another unit with a high death rate.'